Psoriatic arthritis

Question 1

What are the spondyloarthropathies?

Answer 1

• Ankylosing spondylitis (AS)
• Axial spondylitis
• Psoriatic arthritis
• Reactive arthritis
• Enteric arthropathy (IBD arthritis)

Question 2

Describe psoriatic arthritis?

Answer 2

• 10-40% of people with psoriasis
• Can present before skin changes
• Patterns are:
  
  • DIP joints
  • Spinal (like AS)
  • Asymmetrical oligoarthritis
  • Symmetrical polyarthritis (like RA)

Question 3

What are the signs of psoriatic arthritis?

Answer 3

• Radiological
  
  • Erosive changes
  • Severe causes: pencil in cup deformity
• Nail changes
• Synovitis
• Acneiform rashes
• Palmo-plantar pustulosis

Question 4

Describe the management of psoriatic arthritis?

Answer 4

• NSAIDs
• Sulfasalazine / Methotrexate
• Anti-TNF agents

Question 5

What is pictured here?

Answer 5

Pencil in cup deformity

Question 6

What are the features which are common to spondyloarthripathies?

Answer 6

• Asymmetrical inflammatory oligoarthritis
• HLA-B27 associated
• Uveitis
• Enthesitis
• Psoriasis (skin and/or nails)
• Inflammatory bowel disease
• History of inflammatory back pain

Question 7

What does oligoarthritis mean?

Answer 7

2 - 4 joints involved within the first 6 months of disease

Question 8

What is uveitis?

Answer 8

• Eye inflammation
  
  • Middle layer of eye involved (urea)
• Eye redness, pain, blurry vision

Question 9

Name a classification criteria for psoriatic arthritis?

Answer 9

• CASPAR criteria
  
  • ClASsification for Psoriatic AR​thritis

Question 10

Describe the CASPAR criteria for psoriatic arthritis?

Answer 10

• Inflammatory artericular disease (joint, spine, enthesitis)
• • 3 points from the following:
    
    • Current psoriasis (2 points)
    • Psoriasis in family
    • Psoriatic nail dystrophy
    • Negative IgM rheumatoid factor
    • Current dactylitis
    • History of dactylitis
    • Juxta-articular new bone

Question 11

What are the different patterns of Psoriatic arthritis?

Answer 11

• Asymmetrical inflammatory mono/oligoarthritis
• Symmetrical polyarthritis
• Distal IP joint arthritis
• Psoratic spondylitis
• Arthritis mutilans
• Enthesitis-predominant

Question 12

What is pictured here?

Answer 12

Dactylitis

Question 13

What is pictured here?

Answer 13

Distal IP joint pattern of psoriatic arthritis

Question 14

Describe the asymmetrical inflammatory mono/oligoarthritis pattern of psoriatic arthritis?

Answer 14

• Synovitis and periarticular inflammation
• Hands and feet
• Can cause dactylitis (sausage digit)

Question 15

Describe the symmetrical polyarthritis pattern of psoriatic arthritis?

Answer 15

• Women
• Looks like RA
• Involvement of small and large joints in upper and lower limbs
• Nodules and extra-articular manifestations of RA are absent

Question 16

Describe the Distal IP joint arthritis pattern of psoriatic arthritis?

Answer 16

• Can be mistaken for OA
• Associated with psoriatic nail disease

Question 17

Describe the psoriatic spondylitis pattern of psoriatic arthritis?

Answer 17

• Presents with inflammatory back/neck pain
  
  • Stiff symptoms

Question 18

Describe the Arthritis mutilans pattern of psoriatic arthritis?

Answer 18

• Erosive arthritis of fingers and toes
• Cartilage and bone destruction
• Skin appears invaginated and telescoped
  
  • ‘main en lorgnette’

Question 19

Describe the Enthesitis-predominant pattern of psoriatic arthritis?

Answer 19

• Pain and stiffness at tendon insertion sites
• Achilles tendon, plantar fascia, pattelar ligament insertions
• Nail pitting, oncholysis and hyperkeratosis
• Psoriasis rash is widespread

Question 20

Describe the management of Psoriatic arthritis?

Answer 20

• NSAIDs
• Exercise programmes
• Intra-articular glucocorticoid injections
• DMARDs for unresponsive synovitis

Look at BMJ best practice for this slide

Question 21

Case history for psoriatic arthritis